PARENTS' NIGHT OUT
November 30, 2018 -- 5:30-9:00pm
WESTERN SPRINGS BAPTIST CHURCH
4475 Wolf Rd. Western Springs, IL
Contact us: (708) 246-1530 or wsbc@WSBC.info
Parents' First Name *
Your answer
Parents' Last Name *
Your answer
Email *
Your answer
Mobile Phone *
Your answer
Emergency Mobile Phone *
Your answer
TOTAL Children *
CHILD 1
Child #1: First Name *
Your answer
Child #1: Last Name *
Your answer
Child #1: Age & Birthdate *
Your answer
Child #1: PLEASE Identify all Dietary Restrictions and Special Instructions for caring for this child.
Your answer
CHILD 2
Child #2: First Name
Your answer
Child #2: Last Name
Your answer
Child #2: Age & Birthdate
Your answer
Child #2: PLEASE Identify all Dietary Restrictions and Special Instructions for caring for this child.
Your answer
CHILD 3
Child #3: First Name
Your answer
Child #3: Last Name
Your answer
Child #3: Age & Birthdate
Your answer
Child #3: PLEASE Identify all Dietary Restrictions and Special Instructions for caring for this child.
Your answer
CHILD 4
Child #4: Name
Your answer
Child #4: Age & Birthdate
Your answer
Child #4: PLEASE Identify all Dietary Restrictions and Special Instructions for caring for this child.
Your answer
FINAL QUESTIONS
I understand that Parents' Night Out is FREE. Some of the Child Caregiver Staff will be going on a Missions trip later this next year. There will be donation basket available, if you would like to support them on this trip. *
Required
I understand that WESTERN SPRINGS BAPTIST CHURCH | the VILLAGE CHURCH is not responsible for any accidents or injuries, no matter the level of severity, which may occur on, or relating to, WSBCʼs private property. I agree to hold WSBC harmless regarding the care of my child/children. *
Required
I promise to pick up my child/children by 9:00pm & no later. *
Required
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